Form IL-406-1577 "Rehabilitation Labor Receipt" - Illinois

What Is Form IL-406-1577?

This is a legal form that was released by the Illinois Department of Agriculture - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Illinois Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IL-406-1577 by clicking the link below or browse more documents and templates provided by the Illinois Department of Agriculture.

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Download Form IL-406-1577 "Rehabilitation Labor Receipt" - Illinois

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Illinois Department of Agriculture
Bureau of County Fair & Horse Racing
Illinois State Fairgrounds, Box 19281
Springfield, IL 62794-9281
REHABILITATION LABOR RECEIPT
*DONATED LABOR
INCLUDE
(see below).
Submit with Rehabilitation Report.
Laborer’s Name:
________________________________________________________
Address:
________________________________________________________
Date Service Provided:
________________________________________________________
READ CAREFULLY AND COMPLY
1. Labor must be described specifically to be eligible
.
2. “General Maintenance” must be described for eligibility consideration; and
3. Do not list ineligible labor on labor receipt/report (refer to “List of Eligibles” if unsure):
NOTE:
Unless otherwise approved
by IDOA County Fair Office for eligible rehabilitation purposes,
EQUIPMENT and/or LABOR are NOT eligible:
the following
■ OFFICE/KITCHEN HELP AND/OR EQUIPMENT/APPLIANCES
■ OPERATIONAL LABOR INCLUDING CLEANUP
(setting up/tearing down prior to and following fair)
■ CLEANING, MANURE/SNOW REMOVAL/EQUIPMENT and/or GARBAGE REMOVAL
■ EQUIPMENT RENTALS
If labor is not described specifically other than “Gen. Maint”, it will not be eligible
Amount
.
1. __________________________________________________
$ _______________
2. __________________________________________________
_______________
3. __________________________________________________
_______________
4. __________________________________________________
_______________
5. __________________________________________________
_______________
6. __________________________________________________
_______________
7. __________________________________________________
_______________
8.
_______________
__________________________________________________________
$ _______________
TOTAL:
_______________
__________________________________________
DATE:
Laborer’s Signature -
“I hereby certify that I have received payment in full for the above service(s) rendered or donated it.”
*DONATED LABOR:
Effective July 1, 2011 (FY12), donated labor is eligible ONLY as matching funds or cost share for reimbursement described
in the Act. If Donated Labor is NOT labeled as such, it will NOT be considered as match/cost share.
IMPORTANT NOTICE:
This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined
under 30 ILCS 120/1. Failure to provide this information shall prevent this form from being processed. This form has been approved by the State Forms
Management Center. IL-406-1577
90
Illinois Department of Agriculture
Bureau of County Fair & Horse Racing
Illinois State Fairgrounds, Box 19281
Springfield, IL 62794-9281
REHABILITATION LABOR RECEIPT
*DONATED LABOR
INCLUDE
(see below).
Submit with Rehabilitation Report.
Laborer’s Name:
________________________________________________________
Address:
________________________________________________________
Date Service Provided:
________________________________________________________
READ CAREFULLY AND COMPLY
1. Labor must be described specifically to be eligible
.
2. “General Maintenance” must be described for eligibility consideration; and
3. Do not list ineligible labor on labor receipt/report (refer to “List of Eligibles” if unsure):
NOTE:
Unless otherwise approved
by IDOA County Fair Office for eligible rehabilitation purposes,
EQUIPMENT and/or LABOR are NOT eligible:
the following
■ OFFICE/KITCHEN HELP AND/OR EQUIPMENT/APPLIANCES
■ OPERATIONAL LABOR INCLUDING CLEANUP
(setting up/tearing down prior to and following fair)
■ CLEANING, MANURE/SNOW REMOVAL/EQUIPMENT and/or GARBAGE REMOVAL
■ EQUIPMENT RENTALS
If labor is not described specifically other than “Gen. Maint”, it will not be eligible
Amount
.
1. __________________________________________________
$ _______________
2. __________________________________________________
_______________
3. __________________________________________________
_______________
4. __________________________________________________
_______________
5. __________________________________________________
_______________
6. __________________________________________________
_______________
7. __________________________________________________
_______________
8.
_______________
__________________________________________________________
$ _______________
TOTAL:
_______________
__________________________________________
DATE:
Laborer’s Signature -
“I hereby certify that I have received payment in full for the above service(s) rendered or donated it.”
*DONATED LABOR:
Effective July 1, 2011 (FY12), donated labor is eligible ONLY as matching funds or cost share for reimbursement described
in the Act. If Donated Labor is NOT labeled as such, it will NOT be considered as match/cost share.
IMPORTANT NOTICE:
This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined
under 30 ILCS 120/1. Failure to provide this information shall prevent this form from being processed. This form has been approved by the State Forms
Management Center. IL-406-1577
90